Perspective
Parallel Worlds
A medical student discovers threads of her own story in that of an immigrant patient.
By Fran Lebajo Wu
Mr. X didn’t speak English. I’m not sure it would have helped if he had; he seemed so somnolent whenever we would round on him, rarely opening his eyes. Sometimes I wondered if he was trying to ignore me. As a medical student, I did not have much authority, nor did I pretend to. Besides, I looked like I could be his daughter. Was it humiliating to be seen half-naked by someone who might be the same age as his own daughter? I thought of my father and decided that it was.
We came every day. I think we grew on him, and especially on his family. They saw us as often as he did, if not more. There was never a moment when he was alone in his hospital room. His family brought him home-cooked food every day. This was different from the way it was with other patients. I thought, This is the way it should be. Or at least, this is the way I grew up believing it should be. His family was there so often that they started to treat his hospital room as if it were their own space. When we arrived, they would clear things out of the way, move the walker, push the chairs aside, stand up. It was as if they were welcoming us into their home.
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My mother would welcome the friends I brought home from school by clearing a place for them to sit and offering them food. “Sit down! Please have some grapes. Would you like a Coke?” It was her way of making guests feel welcome, even if they said they weren’t staying long, and even if they said they weren’t hungry. But sometimes my friends couldn’t understand my parents, either because of their accent or because of their unconventional way of viewing the world. I often had to play the interpreter.
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If there was no interpreter available, Mr. X’s children would do the job. Their father, whom I imagined to be a stoic, proud man who made sacrifices for his family so that they could survive, was now too weak, too sick, and probably viewed as too simple to understand the finer details of his hospitalization. Perhaps he was encephalopathic and was otherwise a different man. Not only was there a language barrier, but also there was a cultural barrier and likely an educational barrier. The hierarchy had turned upside-down, and the children were now the ones in power, acting as middle-men between their parents and the doctors and influencing decisions.
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I went to my mother’s oncology appointment to smooth the lines of communication. “Doctor, can you please explain our options? My mother does not want traditional chemotherapy.” I could feel the doctor’s suppressed exasperation. My mother was foreign. She appeared to be ignorant. I was American-born, spoke English well, and was in medical school. I could be reasoned with. What person in their right mind succumbs to cancer without a fight? The doctor didn’t understand. My mother grew up in a village without electricity or plumbing. She lived a simple life, and she wanted to die a simple death at home, not in a hospital. She was not afraid of death. She understood what she was doing and believed chemotherapy would make the last moments of her life miserable.
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Mr. X was going to get a second chance at life—a liver had become available and was on its way. Transplant surgery was scheduled for that night or early the next morning. This was the exciting part of medicine. Mr. X’s family was excited, too; numerous family members had gathered in his room and in the halls. The hospital staff did not look favorably on their presence, and attributed Mr. X’s brief episode of tachypnea and tachycardia to their disruptiveness. Mr. X’s son tried to calm his father by telling a story about the first time he kissed a girl. The story seemed too normal, and thus, out of place.
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Over Christmas, my family got together and did the normal things we do during the holiday season. However, we could not ignore the fact that our mom needed a wheelchair to get around. We made a point of doing as much as possible together because we didn’t know if these would be our last moments with her. We held out hope, though. I had a dream in which she was standing at the kitchen sink, washing dishes, and singing—a familiar scene, but one that had not been played out for several months. Perhaps I wanted to believe that some day I would see my mother doing something as ordinary as washing dishes again.
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I had a dream about Mr. X the night the liver became available. I dreamed that the next morning I found him, post-transplant, awake and alert. When I arrived at the hospital, my resident told me the real story. Mr. X had quickly gone into septic shock and had been transferred to the ICU. A new liver was now out of the question. I was crestfallen.
I passed by the ICU a couple days later and found Mr. X’s family crowded into the hall. I spotted his son and asked how everything was.
“We are going to take the life support off,” he told me. “The family is here to say goodbye. Thank you for all your help.”
It was hard to hold back tears. But I was comforted to learn that Mr. X’s family would be allowed to dress him in traditional clothing and say goodbye before taking the machines offline. At least, I thought, they had been allowed a semblance of what they knew as normal in death, despite what modern medicine dictated. I was thankful that Mr. X’s children were there to make his wishes known.
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A week after I dreamed about her standing at the kitchen sink, my mother died at home, as she wished. My sister and brother were at her side. I would like to think that we, her children, made things easier for her by communicating her wishes despite what the doctors recommended. But it was only through her resolve that we could do this for her. Throughout everything she remained realistic about the prospect of death and held her ground about staying at home with minimal treatment. She had a strength and peace that was not of this world.
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The final moments of life are some of the most intimate of the human experience. And now I have experienced these moments both as a daughter and as a future physician. Negotiating two very different worlds—that in which my mother raised me and that of biomedicine—I learned to appreciate how they could each make perfect sense and still be at odds with one another. Seeing my own experience reflected by one of my patients only months after my mother’s death magnified the need for me, as a doctor, to put my patients and their families first by valuing their wishes even if I do not always understand the culture behind them. This way, physician, patient, and family member can face death the same way—with respect and hope. MM
Fran Lebajo Wu is a fourth-year medical student at the University of Minnesota.